Mono (ER Story)

Five-year-old
Tamusina Peavy had a sore throat and a lump on her neck. Her family
doctor thought it was strep, so she prescribed an antibiotic. But
two days later, Tamusina broke out in a rash all over her body.

The rash could mean Tamusina is allergic to the antibiotic amoxicillin. Or
it could mean something else. Dr. Kathleen Nelson examined Tamusina
in the emergency room. She says, “Perhaps she has a condition
called infectious mononucleosis which is a virus infection which
presents with swollen glands and a sore throat and a fever.”

Amoxicillin won’t cure a viral infection. In fact, in one
way, it will make her worse. Dr. Nelson says, “What’s
interesting about that particular infection is that if you give
ampicillin or amoxicillin to children with infectious mononucleosis
almost 100 percent of them develop a rash.”

A blood test confirms that Tamusina has mono. With mono, the antibiotic
rash is itchy but otherwise harmless. It will go away when she
stops taking the medicine. In time, the mono goes away as well.
Dr. Nelson tells Tamusina’s mother, “This infection
sometimes lasts a few weeks, but she looks like she is feeling
much better and I don’t expect that she’s going to
feel worse.”

Doctors say it’s a mystery why amoxicillin causes a rash in
mono patients.

Strep throat and mononucleosis (mono) share some of the same symptoms:

• Fever
• Sore throat
• Headache
• White patches on the back of the throat
• Swollen glands in the neck
• Fatigue
• Loss of appetite

In adolescents, loss of appetite, weakness and sore muscles are common
symptoms associated with mono. Younger children with mono may not have
symptoms other than a general complaint of not feeling well, fever
and loss of appetite.

The American Medical Association (AMA) says that of all age groups,
adolescents are most likely to have the classic symptoms of fatigue,
fever, sore throat and swollen glands. Some suffer extreme fatigue.

Strep throat and mononucleosis differ in their causes and treatments.
Strep throat is caused by a bacteria called group A streptococcus.
Once strep has been diagnosed by a healthcare professional, it will
be treated with antibiotics.

Classic mono is caused by the Epstein-Barr virus. Since mononucleosis
is a viral infection, antibiotics are not effective in treating it.

Mononucleosis is a viral infection passed from person
to person in saliva, coughs and sneezes, and through close (mouth-to-mouth)
contact. This close contact gives mono the nickname “the kissing
disease.” We generally think of mono as an illness among teenagers,
but young children also get mono.

Signs of mono usually develop four to seven weeks after exposure
to the virus. Generally, people will have only one attack of mono
in a lifetime. According to the American Academy of Family Physicians,
mono is most common among people 15 to 35 years of age.

Mono is diagnosed after a discussion of symptoms with a physician,
and is confirmed by blood tests.

The illness usually runs its course without too many problems. The
AMA says the sore throat and fever usually subside after about two
weeks, but enlarged lymph nodes (swollen glands) and an enlarged spleen
may persist for a few weeks more. Fatigue and weakness may last for
months in some cases. If a child has experienced a swollen spleen
during the course of the illness, he/she should not participate in
athletic events for three to four months, or until the spleen has
returned to normal size. This will help protect against a rupture
of the spleen.

Though not common, complications are can occur with mono, and some
of them can be serious. The AMA lists these possible complications:

• Blood disorders
• Rupture of the spleen
• Inflammation of the heart muscle
• Inflammation of the brain or its covering membranes
• Guillian-Barre syndrome, a paralyzing disorder

Uncomplicated cases of mono are usually managed at home with steps
taken to relieve the symptoms. The AAFP advises the following:

• Rest
• Drink plenty of fluids
• Gargle with salt water, or suck on lozenges, hard candy or flavored
  frozen desserts to relieve throat pain
• Acetaminophen or ibuprofen
  to relieve pain and fever – DO NOT
  GIVE ASPIRIN

American Academy of
Family Physicians
American Medical Association
University of Wisconsin-Madison